Browsing by Author "Ifeachor, Amanda P."

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    Assessment of hepatitis C monitoring adherence after viral eradication in veterans with substance use to improve care and surveil reinfection
    (American Association of Psychiatric Pharmacists, 2022-06-10) Stratton, Miranda L.; Ansara, Elayne D.; Ifeachor, Amanda P.; Houck, Kelly K.; Liangpunsakul, Suthat; Binger, Katie J.; Medicine, School of Medicine
    Introduction: Hepatitis C virus (HCV) incidence rates are rising for patients with substance use and/or SUDs. Guidelines provide monitoring recommendations to ensure remission after successful treatment. The study's objective was to identify gaps in follow-up for patients with documented substance use and/or SUD through assessment of adherence to guideline-recommended HCV RNA lab 12 months post-treatment. Methods: Patients treated for HCV through the Veteran Health Indiana Hepatitis C Pharmacy Clinic were retrospectively evaluated. Subjects were categorized based on the provider assigned for follow-up care after 12-week sustained virologic response (SVR12) labs (primary care provider [PCP] or HCV provider). The primary outcome was HCV RNA obtained 11 to 13 months post-treatment. Secondary outcomes were HCV RNA detected post-treatment, substance use, engagement in substance use treatment, and engagement with social work. Results: Two hundred forty-one patients were included in the HCV provider cohort and 139 in the PCP cohort. Forty-one patients did not have a specified clinic for follow-up treatment, and 20 patients did not achieve SVR12. Sixty-one patients (28%) in the HCV provider cohort completed a 12-month HCV RNA within 11 to 13 months post-treatment vs 15 patients (11%) in the PCP cohort (P ≤ .01). One patient had HCV RNA detected post-treatment. Discussion: This study reveals inadequate HCV post-treatment follow-up for patients with substance use and/or SUD. SUD is a chronic disease that requires continued monitoring to prevent complications. Further studies are needed to identify reinfection rates and improvements of care in this population.
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    Care Coordination Strategies and Barriers during Medication Safety Incidents: a Qualitative, Cognitive Task Analysis
    (Springer, 2021) Russ-Jara, Alissa L.; Luckhurst, Cherie L.; Dismore, Rachel A.; Arthur, Karen J.; Ifeachor, Amanda P.; Militello, Laura G.; Glassman, Peter A.; Zillich, Alan J.; Weiner, Michael; Medicine, School of Medicine
    Background: Medication errors are prevalent in healthcare institutions worldwide, often arising from difficulties in care coordination among primary care providers, specialists, and pharmacists. Greater knowledge about care coordination surrounding medication safety incidents can inform efforts to improve patient safety. Objectives: To identify strategies that hospital and outpatient healthcare professionals (HCPs) use, and barriers encountered, when they coordinate care during a medication safety incident involving an adverse drug reaction, drug-drug interaction, or drug-renal concern. Design: We asked HCPs to complete a form whenever they encountered these incidents and intervened to prevent or mitigate patient harm. We stratified incidents across HCP roles and incident categories to conduct follow-up cognitive task analysis interviews with HCPs. Participants: We invited all physicians and pharmacists working in inpatient or outpatient care at a tertiary Veterans Affairs Medical Center. We examined 24 incidents: 12 from physicians and 12 from pharmacists, with a total of 8 incidents per category. Approach: Interviews were transcribed and analyzed via a two-stage inductive, qualitative analysis. In stage 1, we analyzed each incident to identify decision requirements. In stage 2, we analyzed results across incidents to identify emergent themes. Key results: Most incidents (19, 79%) were from outpatient care. HCPs relied on four main strategies to coordinate care: cognitive decentering; collaborative decision-making; back-up behaviors; and contingency planning. HCPs encountered four main barriers: role ambiguity and constraints, breakdowns (e.g., delays) in care, challenges related to the electronic health record, and factors that increased coordination complexity. Each strategy and barrier occurred across all incident categories and HCP groups. Pharmacists went to extra effort to ensure safety plans were implemented. Conclusions: Similar strategies and barriers were evident across HCP groups and incident types. Strategies for enhancing patient safety may be strengthened by deliberate organizational support. Some barriers could be addressed by improving work systems.
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    Long-Term Assessment of Weight Loss Medications in a Veteran Population
    (MDedge, 2024) Rodriguez, Allison D.; Ifeachor, Amanda P.; Moore, Emily A.; Otte, Cassandra F.; Schopper, M. Joseph; Liangpunsakul, Suthat; Lteif, Amale A.; Medicine, School of Medicine
    Background: Overweight and obesity are common in the veteran population. Medical management with semaglutide, orlistat, liraglutide, phentermine, phentermine/topiramate, and naltrexone/bupropion is increasingly common. This study expands on a 2021 study and evaluates medication effectiveness. Methods: This single-center retrospective study analyzed patients prescribed weight loss medications at Veteran Health Indiana. Primary outcomes included body weight loss and total weight loss with each medication at 3, 6, 12, 24, 36, and 48 months. Secondary outcomes were also used to determine the efficacy of the current weight loss medications. Results: Of 105 included patients, 66 were treated with liraglutide, 30 with phentermine/topiramate, 5 with naltrexone/bupropion, 3 with orlistat, and 1 with phentermine. The absolute weight loss for all medications was 10.6 kg over the patient-specific duration of weight management therapy. The mean body weight loss was 9.2%. There were no statistically significant differences in primary or secondary outcomes between liraglutide and phentermine/topiramate. The group sizes were too small to analyze the other medication groups. Conclusions: Patients in this study lost weight while using medications. However, there were no statistically significant differences among the medications. Patients did not receive uniformly consistent follow-up care, suggesting the need for more standardized processes that could lead to better weight loss outcomes.